MedicaidPrior AuthHigh impact
Medicaid Alert MA2020-03
New Jersey Medicaid·NJ·Prior Authorization
Effective date
Apr 1, 2020
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid has suspended prior authorization requirements for Community Support Services (CSS) effective April 1, 2020, due to COVID-19 emergency declaration. Providers must continue billing in accordance with Medicaid rules, maintain documentation, and verify eligibility, with extended coverage for beneficiaries scheduled to terminate.
Action Required
Effective immediately (April 1, 2020): (1) Billing team and providers must STOP submitting prior authorization requests for CSS services to the Interim Managing Entity (IME); (2) Remove prior auth requirement from billing workflows and encounter forms for CSS services; (3) Continue verifying Medicaid eligibility for all beneficiaries before billing; (4) Maintain detailed documentation for all CSS services provided during the COVID-19 state of emergency; (5) Continue billing Medicaid per existing Federal and State guidance; (6) For beneficiaries with March 2020 termination dates, extend eligibility through the COVID-19 state of emergency period. Non-compliance risks claim denials if prior auth is incorrectly obtained or if documentation is insufficient. Monitor njmmis.com and nj.gov/humanservices for updates on when prior auth requirements resume.